New measles case in Victoria

What is the issue?

A new case of measles has been identified in a returned overseas traveller. There have been a total of 4 cases of measles identified in Victoria since 1 January 2023. Measles is a highly infectious viral illness that can lead to uncommon but serious complications, such as pneumonia and brain inflammation (encephalitis).

Any overseas travel could lead to exposure to measles at the current time. Outbreaks of measles have been recently reported in Asia (including Indonesia and India), Africa, Europe, and the USA.

The case attended a single public exposure site in Melbourne on 20 September 2023 while infectious, listed in the table below.

Anyone who attended the listed exposure site during the specified date and time should monitor for symptoms and seek medical care if symptoms develop.

Anyone who presents with signs and symptoms compatible with measles should be tested and notified to the Department of Health. There should be an especially high level of suspicion if they have travelled overseas or visited any the site listed above and are unvaccinated or partially vaccinated for measles.

Who is at risk?

Any person born during or since 1966 and who does not have documented evidence of receiving two doses of a measles-containing vaccine or does not have documented evidence of immunity, is at risk.

Unvaccinated infants are at particularly high risk of contracting measles. Infants as young as six months of age can receive MMR vaccine prior to travel overseas to countries where measles is endemic, or where measles outbreaks are occurring. The first dose of MMR vaccine is usually given at 12 months of age as part of the National Immunisation Program Schedule (NIP). If an infant receives an early dose of MMR vaccine (e.g. at 8 months) prior to travelling overseas, they are still required to receive their routine 12 month and 18 months doses in line with the NIP schedule. MMR vaccine is free for infants aged 6 to 12 months travelling to measles affected areas.

Young infants, pregnant women and people with a weakened immune system are at increased risk of serious complications from measles.

Symptoms and transmission

Symptoms of measles include fever, severe cough, sore or red eyes (conjunctivitis) and runny nose (coryza), followed by a maculopapular rash usually starting on the face before spreading down the body. Symptoms can develop 7 to 18 days after exposure.

Initial symptoms of measles may be similar to those of COVID-19 and influenza. If a symptomatic patient tests negative for COVID-19 and/or influenza but develops a rash, they should be advised to continue isolating and be tested for measles.

People with measles are potentially infectious from around 5 days before, to 4 days after the rash appears. Measles is highly infectious and can stay in the environment for up to 2 hours.

These pictures are typical of a measles rash.

Recommendations

For the general public

• Anyone who attended the listed exposure sites during the specified dates and times may have been exposed to measles and should monitor for symptoms.
• Anyone who develops symptoms of measles should seek medical care. Call the health service beforehand to advise that you have been exposed to measles and wear a mask.
• The measles-mumps-rubella (MMR) vaccine is safe and effective protection against measles. All adolescents and adults born after 1966 who are unsure if they have been vaccinated, are incompletely vaccinated or do not have evidence of immunity to measles are recommended to receive the free measles-containing vaccine. Speak to your immunisation provider for further information.
• Anyone planning overseas travel should ensure they have received vaccinations appropriate for travel.

For health professionals

• Be alert for measles in patients presenting with fever and rash, particularly those with overseas travel or who attended the listed exposure sites during the specified dates and times.
• Suspected cases should be tested, isolated and notified to the Department of Health immediately by calling 1300 651 160.
• Take blood samples for measles serology in all suspected cases.
• Discuss the need for PCR testing using nose and throat swabs with the Department of Health (PCR testing for measles does not attract a Medicare rebate).
• Minimise the risk of measles transmission within your practice/department:
  • Avoid keeping patients with fever and rash in shared waiting areas
  • If measles is suspected, give the patient a single-use fitted mask and isolate them until a measles diagnosis can be excluded
  • Leave all rooms used to assess the suspected case vacant for at least 30 minutes after the consultation
• Offer MMR vaccine to people born after 1966 who do not have documented evidence of receiving two doses of a measles-containing vaccine or documented evidence of immunity. Serology is not required before vaccinating. People who are not Medicare eligible can also receive the free MMR vaccine. Refer to the Australian Immunisation Handbook – Measles for further guidance on immunisation.